Discretionary Spending

Chad sat on the exam table with an elegant black bag from Amphora, a local purveyor of high-end skin care products.

"I need a prescription for Protopic," he said.

"I'll put in for Prior Authorization," I replied. "But your insurance may not cover it."

So he asked for samples. Then he asked for a prescription for Propecia. Then he asked about Botox and Restylane.

People's attitudes toward spending money can be hard to figure. Take Eunice, for example, who came by later the same day for me to remove a lesion on her shin that biopsy had shown to be a basal cell carcinoma. She showed me another spot on her arm.

"Could be the same thing," I said.

"The last biopsy cost me $127 after insurance," she said. "Must you biopsy this one, too?"

I told her that I must.

While I curetted her leg and arm, Eunice reported on her recent trip. "The cruise was fabulous," she said. "We've tried different lines, but Royal Flushing is the best. There are thousands of passengers, but you always feel like you're getting personal service."

"Where did you go?" I asked.

"Athens, the Greek islands, Rome, Venice. You know what the best part was—Lido. It's a small island near Venice, away from the tourists, very quiet, really lovely."

And not covered by health insurance, presumably.

So it's okay to spend money on Propecia, Botox, and Lido, but not on Protopic or a biopsy.

But the paradox is only apparent, not real. In fact, people divide the world in two: things you're supposed to pay for and things somebody else is supposed to pay for. What matters is not the size of the expenditure, but the category. How things get classified is a matter for economic anthropologists to figure out. But get classified they do.

I mention Chad and Eunice not just because they're fresh in my mind but because they're middle class. The kind of paradoxical economic behavior I'm describing is more often blamed on "welfare queens." Money for frivolities while stinting the essentials.

Not that I exempt myself from such attitudes. I confess to irritation when Mrs. Will Medicaid Cover This? tells me about her recent jaunt to somewhere tropical. The phenomenon, however, is not limited to the poor, or to the bourgeoisie, petty or haute, which brings me to the wealthy.

Gilbert drops by twice a year. He tells me about his efforts to raise funds for his alma mater, a venerable and well-endowed southern institute of higher learning of which he is very proud.

"We set a goal of $1.3 billion for our capital campaign," he told me recently. "But we're already over a billion, so we've raised the goal to $1.7 billion."

I would have whistled if I knew how.

Gilbert went on to tell me about recruitment. "You might think we wouldn't do this with competitors," he said, "But we recruit with a consortium of other universities from our neck of the woods. It's more economical that way.

"Someone messed up when the recruiters went out to Denver last year and didn't book the hall we use every year. So they called one of the local private prep schools and asked about using an auditorium. They said sure, but it was going to cost $1,800. Can you imagine?

"So we said, hey, there's this consortium of well-known southern schools coming to your place. Our being there will do a lot for your prestige.

"They agreed that it would, and they'd be delighted to have us, but for $1,800."

"What did you do?" I asked him.

Gilbert smiled. "I have some contacts out there." He said. "One of them is a charter member of the Presbyopia Hunt Club. We used their facility, which worked out fine. It cost us $750."

Money for endowments? Check. Money for buildings and grounds? Check. Money for salaries? Nah, I know too many professors and postdoctorates to think that's the case.

Now if I were going on grandly about 10-figure sums, I would be, well, embarrassed to brag about how I saved a grand off somebody's standard fee which they didn't have the sense to discount for the honor of serving me. But that's just me.

The point is that no single class has a monopoly on inscrutable economic behavior. One should therefore be understanding and sympathetic to all. But the flesh is weak, and some people are, for me at least, a little harder to sympathize with.

Chad sat on the exam table with an elegant black bag from Amphora, a local purveyor of high-end skin care products.

"I need a prescription for Protopic," he said.

"I'll put in for Prior Authorization," I replied. "But your insurance may not cover it."

So he asked for samples. Then he asked for a prescription for Propecia. Then he asked about Botox and Restylane.

People's attitudes toward spending money can be hard to figure. Take Eunice, for example, who came by later the same day for me to remove a lesion on her shin that biopsy had shown to be a basal cell carcinoma. She showed me another spot on her arm.

"Could be the same thing," I said.

"The last biopsy cost me $127 after insurance," she said. "Must you biopsy this one, too?"

I told her that I must.

While I curetted her leg and arm, Eunice reported on her recent trip. "The cruise was fabulous," she said. "We've tried different lines, but Royal Flushing is the best. There are thousands of passengers, but you always feel like you're getting personal service."

"Where did you go?" I asked.

"Athens, the Greek islands, Rome, Venice. You know what the best part was—Lido. It's a small island near Venice, away from the tourists, very quiet, really lovely."

And not covered by health insurance, presumably.

So it's okay to spend money on Propecia, Botox, and Lido, but not on Protopic or a biopsy.

But the paradox is only apparent, not real. In fact, people divide the world in two: things you're supposed to pay for and things somebody else is supposed to pay for. What matters is not the size of the expenditure, but the category. How things get classified is a matter for economic anthropologists to figure out. But get classified they do.

I mention Chad and Eunice not just because they're fresh in my mind but because they're middle class. The kind of paradoxical economic behavior I'm describing is more often blamed on "welfare queens." Money for frivolities while stinting the essentials.

Not that I exempt myself from such attitudes. I confess to irritation when Mrs. Will Medicaid Cover This? tells me about her recent jaunt to somewhere tropical. The phenomenon, however, is not limited to the poor, or to the bourgeoisie, petty or haute, which brings me to the wealthy.

Gilbert drops by twice a year. He tells me about his efforts to raise funds for his alma mater, a venerable and well-endowed southern institute of higher learning of which he is very proud.

"We set a goal of $1.3 billion for our capital campaign," he told me recently. "But we're already over a billion, so we've raised the goal to $1.7 billion."

I would have whistled if I knew how.

Gilbert went on to tell me about recruitment. "You might think we wouldn't do this with competitors," he said, "But we recruit with a consortium of other universities from our neck of the woods. It's more economical that way.

"Someone messed up when the recruiters went out to Denver last year and didn't book the hall we use every year. So they called one of the local private prep schools and asked about using an auditorium. They said sure, but it was going to cost $1,800. Can you imagine?

"So we said, hey, there's this consortium of well-known southern schools coming to your place. Our being there will do a lot for your prestige.

"They agreed that it would, and they'd be delighted to have us, but for $1,800."

"What did you do?" I asked him.

Gilbert smiled. "I have some contacts out there." He said. "One of them is a charter member of the Presbyopia Hunt Club. We used their facility, which worked out fine. It cost us $750."

Money for endowments? Check. Money for buildings and grounds? Check. Money for salaries? Nah, I know too many professors and postdoctorates to think that's the case.

Now if I were going on grandly about 10-figure sums, I would be, well, embarrassed to brag about how I saved a grand off somebody's standard fee which they didn't have the sense to discount for the honor of serving me. But that's just me.

The point is that no single class has a monopoly on inscrutable economic behavior. One should therefore be understanding and sympathetic to all. But the flesh is weak, and some people are, for me at least, a little harder to sympathize with.

Chad sat on the exam table with an elegant black bag from Amphora, a local purveyor of high-end skin care products.

"I need a prescription for Protopic," he said.

"I'll put in for Prior Authorization," I replied. "But your insurance may not cover it."

So he asked for samples. Then he asked for a prescription for Propecia. Then he asked about Botox and Restylane.

People's attitudes toward spending money can be hard to figure. Take Eunice, for example, who came by later the same day for me to remove a lesion on her shin that biopsy had shown to be a basal cell carcinoma. She showed me another spot on her arm.

"Could be the same thing," I said.

"The last biopsy cost me $127 after insurance," she said. "Must you biopsy this one, too?"

I told her that I must.

While I curetted her leg and arm, Eunice reported on her recent trip. "The cruise was fabulous," she said. "We've tried different lines, but Royal Flushing is the best. There are thousands of passengers, but you always feel like you're getting personal service."

"Where did you go?" I asked.

"Athens, the Greek islands, Rome, Venice. You know what the best part was—Lido. It's a small island near Venice, away from the tourists, very quiet, really lovely."

And not covered by health insurance, presumably.

So it's okay to spend money on Propecia, Botox, and Lido, but not on Protopic or a biopsy.

But the paradox is only apparent, not real. In fact, people divide the world in two: things you're supposed to pay for and things somebody else is supposed to pay for. What matters is not the size of the expenditure, but the category. How things get classified is a matter for economic anthropologists to figure out. But get classified they do.

I mention Chad and Eunice not just because they're fresh in my mind but because they're middle class. The kind of paradoxical economic behavior I'm describing is more often blamed on "welfare queens." Money for frivolities while stinting the essentials.

Not that I exempt myself from such attitudes. I confess to irritation when Mrs. Will Medicaid Cover This? tells me about her recent jaunt to somewhere tropical. The phenomenon, however, is not limited to the poor, or to the bourgeoisie, petty or haute, which brings me to the wealthy.

Gilbert drops by twice a year. He tells me about his efforts to raise funds for his alma mater, a venerable and well-endowed southern institute of higher learning of which he is very proud.

"We set a goal of $1.3 billion for our capital campaign," he told me recently. "But we're already over a billion, so we've raised the goal to $1.7 billion."

I would have whistled if I knew how.

Gilbert went on to tell me about recruitment. "You might think we wouldn't do this with competitors," he said, "But we recruit with a consortium of other universities from our neck of the woods. It's more economical that way.

"Someone messed up when the recruiters went out to Denver last year and didn't book the hall we use every year. So they called one of the local private prep schools and asked about using an auditorium. They said sure, but it was going to cost $1,800. Can you imagine?

"So we said, hey, there's this consortium of well-known southern schools coming to your place. Our being there will do a lot for your prestige.

"They agreed that it would, and they'd be delighted to have us, but for $1,800."

"What did you do?" I asked him.

Gilbert smiled. "I have some contacts out there." He said. "One of them is a charter member of the Presbyopia Hunt Club. We used their facility, which worked out fine. It cost us $750."

Money for endowments? Check. Money for buildings and grounds? Check. Money for salaries? Nah, I know too many professors and postdoctorates to think that's the case.

Now if I were going on grandly about 10-figure sums, I would be, well, embarrassed to brag about how I saved a grand off somebody's standard fee which they didn't have the sense to discount for the honor of serving me. But that's just me.

The point is that no single class has a monopoly on inscrutable economic behavior. One should therefore be understanding and sympathetic to all. But the flesh is weak, and some people are, for me at least, a little harder to sympathize with.